PCCN PRACTICE QUESTIONS AND WELL
VERIFIED ANSWERS 2024/2025
Coronary -artery -perfusion -is -dependent -upon:
A. -diastolic -pressure
B. -systolic -pressure
C. -afterload
D. -systemic -vascular -resistance -(SVR) -- -CORRECT -ANSWER-A. -diastolic -pressure
Diastolic -pressure -in -the -aortic -root -is -higher -than -left -ventricular -end-diastolic -pressure -
(LVEDP), -the -pressure -exerted -on -the -ventricular -muscle -at -the -end -of -diastole -when -the -
ventricle -is -full. -This -enables -blood -to -flow -from -a -higher -pressure -through -open -arteries -to -a
-lower -pressure, -a -pressure -gradient -known -as -coronary -artery -prefusion -pressure. -As -diastolic -
pressure -drops, -there -is -a -decrease -in -coronary -artery -blood -flow. -Coronary -artery -perfusion -is
-not -affected -by -systolic -pressure, -afterload -or -SVR, -but -they -all -increase -the -demand -of -
oxygen -in -the -heart.
A -post-STEMI -(ST -elevation -myocardial -infarction) -patient -is -started -on -an -angiotensin-converting
-enzyme -(ACE) -inhibitor -during -his -hospital -stay. -Which -of -the -following -is -the -most -common -
serious -side -effect -that -may -occur?
A. -a -nonproductive -cough
B. -pedal -edema
C. -swelling -of -the -tongue -and -face
D. -rhinorrhea -- -CORRECT -ANSWER-C. -swelling -of -the -tongue -and -face
Although -all -of -the -answers -may -occur, -swelling -og -the -tongue -and -face -is -the -most -serious -
and -may -require -intervention. -Patients -should -be -instructed -to -seek -medical -attention -
immediately -for -any -signs -of -swelling -in -the -tongue -or -throat.
Which -of -the -following -best -describes -the -fourth -heart -sound -(S4):
A. -It -occurs -after -ventricular -contraction
B. -It -is -best -heard -with -the -diaphragm -of -the -stethoscope
C. -It -is -a -normal -finding -in -children
,D. -It -occurs -during -late -diastole -when -the -atria -contracts -- -CORRECT -ANSWER-D. -It -occurs -
during -late -diastole -when -the -atria -contracts
The -presence -of -the -extra -heart -sound -S4 -signifies -a -poorly -compliant -(stiff) -left -ventricle. -An -
S4 -is -also -called -an -atrial -heart -sound -since -it -occurs -at -the -end -of -diastolic -filling -when -the -
atria -contracts -and -fully -fills -the -left -ventricle. -Known -as -"atrial -kick", -this -filling -is -important -
to -cardiac -output. -The -increased -end-diastolic -volume -in -the -ventricle -improves -cardiac -output.
-When -the -left -ventricle -is -stiff -(decreased -compliance -with -long -term -hypertension, -aortic -
stenosis -or -with -acute -STEMI), -the -atrium -has -to -pump -harder -to -move -blood -from -the -
atrium -to -the -ventricle, -causing -a -turbulent -blood -flow -and -extra -heart -sound. -This -heart -
sound -is -always -pathologic. -It -occurs -before -ventricular -contraction, -is -best -heard -with -the -bell
-of -the -stethoscope -and -is -never -a -normal -heart -sound, -even -in -children.
Which -pathologic -changes -found -on -the -12-lead -ECG -indicate -myocardial -ischemia?
A. -ST-segment -elevation
B. -ST-segment -depression -and -T-wave -elevation
C. -Q-wave -formation
D. -ST-segment -depression -and -T-wave -inversion -- -CORRECT -ANSWER-D. -ST -segment -depression -
and -T -wave -inversion
Myocardial -ischemia -changes -the -repolarization -of -the -ventricular -muscle. -That -change -is -seen -
on -the -12 -lead -ECG -as -ST-segment -depression -and -T -wave -inversion, -which -demonstrate -
subendocardial -ischemia --- -the -innermost -layer -of -muscle -in -the -myocardium. -ST-segment -
elevation -indicates -acute -injury -or -infarction, -ST -segment -depression -and -T -wave -elevation -may
-indicate -an -electrolyte -abnormality, -while -Q -wave -formation -indicates -total -infarction.
Positive -inotropic -agents -are -used -to:
A. -improve -cardiac -output -and -tissue -perfusion
B. -decrease -water -loss -through -the -kidneys
C. -increase -heart -rate
D. -vasodilate -vessels -- -CORRECT -ANSWER-A. -improve -cardiac -output -and -tissue -perfusion
The -term -"inotropic" -refers -to -affecting -the -force -of -myocardial -contraction. -Improvement -of -
cardiac -muscle -contraction -leads -to -improved -cardiac -output -and -tissue -perfusion.
A -patient -in -the -ED -is -now -being -admitted -to -telemetry -bwith -complaint -of -chest -pain -and -
has -been -judged -to -be -a -possible -candidate -for -therapy -with -alteplase -(Activase). -Which -of -
the -following -is -not -considered -a -contraindication -for -the -use -of -this -medication?
,A. -current -antibiotic -use
B. -recent -abdominal -surgery
C. -recent -gastrointestinal -bleed
D. -recent -intracranial -bleed -- -CORRECT -ANSWER-A. -current -antibiotic -use
Use -of -antibiotics -is -not -a -contraindication -for -the -use -of -alteplase. -All -the -other -answers --- -
recent -abdominal -surgery, -recent -gastrointestinal -bleeding -and -a -recent -intracranial -bleed --- -are
-contraindications -for -the -use -of -any -fibrinolytic.
The -two -major -components -that -determine -blood -pressure -are:
A. -systemic -vascular -resistance -(SVR) -(afterload) -and -cardiac -output
B. -contractility -and -SVR -(afterload)
C. -preload -and -SVR -(afterload)
D. -contractility -and -SVR -(afterload) -- -CORRECT -ANSWER-A. -SVR -(afterload) -and -cardiac -output
The -equation -for -BP -is: -BP -= -SVR -x -cardiac -output.
BP -is -determined -by -resistance -of -the -arterial -bed -and -the -cardiac -output. -If -the -SVR -
(afterload) -is -high -and -the -cardiac -output -low, -the -patient -may -still -have -a -normal -BP. -the -
pulse -pressure -will -be -lower, -but -this -is -a -compensatory -response -by -the -heart -to -maintain -
BP. -If -the -SVR -(afterload) -is -low -(as -in -early -septic -shock), -the -cardiac -output -is -very -high, -
thereby -trying -to -support -BP.
The -layer -of -the -arterial -vessel -wall -responsible -for -changes -in -the -diameter -of -the -artery -is -
the:
A. -media
B. -intima
C. -externa
D. -adventitia -- -CORRECT -ANSWER-A. -media
The -media -layer -of -the -arterial -wall -contains -vascular -smooth -muscle -cells -and -is -responsible -
for -arterial -tone. -Vasoactive -substances -released -in -response -to -the -sympathetic -nervous -system
-and/or -the -renin-angiotensin -system -determine -arterial -tone. -Intima, -externa -and -adventitia -are
-incorrect.
A -patient -presents -in -acute -distress -with -rales -halfway -up -bilaterally; -cool -and -clammy -
extremities; -elevated -jugular -venous -distention -(JVD); -oxygen -saturations -at -95%, -down -from -
, 99%; -and -complaints -of -shortness -of -breath. -Which -of -the -following -findings -correspond -to -the
-patient's -cardiac -status?
A. -no -pulmonary -congestion, -normal -perfusion
B. -no -pulmonary -congestion, -low -perfusion
C. -pulmonary -congestion, -normal -perfusion
D. -pulmonary -congestion, -low -perfusion -- -CORRECT -ANSWER-D. -pulmonary -congestion, -low -
perfusion
Rales -indicate -fluid -in -the -alveolar -sacs, -possibly -secondary -to -pulmonary -edema, -causing -
pulmonary -congestion. -Pneumonia -can -also -cause -fluid -in -the -alveolar -sacs. -The -patient -is -
complaining -of -shortness -of -breath, -and -the -oxygen -saturations -are -lowering, -also -indicating -
that -the -patient -has -pulmonary -congestion. -The -patient's -skin -is -cool -and -clammy, -indicating -
that -the -skin -is -poorly -perfused. -Skin -does -not -require -oxygen -and -shunts -blood -away -in -
decreased -cardiac -function; -therefore, -this -patient -has -pulmonary -congestion -and -low -perfusion
-state. -The -other -answers -are -incorrect.
When -listening -to -heart -sounds, -S1 -signifies -which -of -the -following?
A. -the -beginning -of -ventricular -systole
B. -the -beginning -of -ventricular -diastole
C. -the -propulsion -of -blood -into -a -non-compliant -ventricle
D. -the -blood -going -in -the -wrong -direction -- -CORRECT -ANSWER-A. -the -beginning -of -ventricular -
systole
The -heart -sound -of -S1 -indicates -the -opening -of -the -aortic -and -pulmonic -valves -and -marks -the
-beginning -of -ventricular -systole -or -ejection. -The -beginning -of -diastole -is -after -S2, -propulsion -
of -blood -into -a -noncompliant -chamber -is -S4, -and -blood -going -in -the -wrong -direction -will -
cause -a -murmur.
A -patient -with -pulmonary -edema -has -impaired -diffusion -due -to:
A. -increased -thickness -of -the -alveolar -capillary -membrane
B. -retaining -CO2
C. -an -elevated -body -temperature -associated -with -pulmonary -edema
D. -low -barometric -pressure -- -CORRECT -ANSWER-A. -increased -thickness -of -the -alveolar -capillary -
membrane
With -increasing -left -ventricular -pressures, -blood -moves -back -into -the -left -atrium, -then -to -the -
pulmonary -veins. -When -the -pressure -in -the -pulmonary -veins -increases, -capillary -function -
VERIFIED ANSWERS 2024/2025
Coronary -artery -perfusion -is -dependent -upon:
A. -diastolic -pressure
B. -systolic -pressure
C. -afterload
D. -systemic -vascular -resistance -(SVR) -- -CORRECT -ANSWER-A. -diastolic -pressure
Diastolic -pressure -in -the -aortic -root -is -higher -than -left -ventricular -end-diastolic -pressure -
(LVEDP), -the -pressure -exerted -on -the -ventricular -muscle -at -the -end -of -diastole -when -the -
ventricle -is -full. -This -enables -blood -to -flow -from -a -higher -pressure -through -open -arteries -to -a
-lower -pressure, -a -pressure -gradient -known -as -coronary -artery -prefusion -pressure. -As -diastolic -
pressure -drops, -there -is -a -decrease -in -coronary -artery -blood -flow. -Coronary -artery -perfusion -is
-not -affected -by -systolic -pressure, -afterload -or -SVR, -but -they -all -increase -the -demand -of -
oxygen -in -the -heart.
A -post-STEMI -(ST -elevation -myocardial -infarction) -patient -is -started -on -an -angiotensin-converting
-enzyme -(ACE) -inhibitor -during -his -hospital -stay. -Which -of -the -following -is -the -most -common -
serious -side -effect -that -may -occur?
A. -a -nonproductive -cough
B. -pedal -edema
C. -swelling -of -the -tongue -and -face
D. -rhinorrhea -- -CORRECT -ANSWER-C. -swelling -of -the -tongue -and -face
Although -all -of -the -answers -may -occur, -swelling -og -the -tongue -and -face -is -the -most -serious -
and -may -require -intervention. -Patients -should -be -instructed -to -seek -medical -attention -
immediately -for -any -signs -of -swelling -in -the -tongue -or -throat.
Which -of -the -following -best -describes -the -fourth -heart -sound -(S4):
A. -It -occurs -after -ventricular -contraction
B. -It -is -best -heard -with -the -diaphragm -of -the -stethoscope
C. -It -is -a -normal -finding -in -children
,D. -It -occurs -during -late -diastole -when -the -atria -contracts -- -CORRECT -ANSWER-D. -It -occurs -
during -late -diastole -when -the -atria -contracts
The -presence -of -the -extra -heart -sound -S4 -signifies -a -poorly -compliant -(stiff) -left -ventricle. -An -
S4 -is -also -called -an -atrial -heart -sound -since -it -occurs -at -the -end -of -diastolic -filling -when -the -
atria -contracts -and -fully -fills -the -left -ventricle. -Known -as -"atrial -kick", -this -filling -is -important -
to -cardiac -output. -The -increased -end-diastolic -volume -in -the -ventricle -improves -cardiac -output.
-When -the -left -ventricle -is -stiff -(decreased -compliance -with -long -term -hypertension, -aortic -
stenosis -or -with -acute -STEMI), -the -atrium -has -to -pump -harder -to -move -blood -from -the -
atrium -to -the -ventricle, -causing -a -turbulent -blood -flow -and -extra -heart -sound. -This -heart -
sound -is -always -pathologic. -It -occurs -before -ventricular -contraction, -is -best -heard -with -the -bell
-of -the -stethoscope -and -is -never -a -normal -heart -sound, -even -in -children.
Which -pathologic -changes -found -on -the -12-lead -ECG -indicate -myocardial -ischemia?
A. -ST-segment -elevation
B. -ST-segment -depression -and -T-wave -elevation
C. -Q-wave -formation
D. -ST-segment -depression -and -T-wave -inversion -- -CORRECT -ANSWER-D. -ST -segment -depression -
and -T -wave -inversion
Myocardial -ischemia -changes -the -repolarization -of -the -ventricular -muscle. -That -change -is -seen -
on -the -12 -lead -ECG -as -ST-segment -depression -and -T -wave -inversion, -which -demonstrate -
subendocardial -ischemia --- -the -innermost -layer -of -muscle -in -the -myocardium. -ST-segment -
elevation -indicates -acute -injury -or -infarction, -ST -segment -depression -and -T -wave -elevation -may
-indicate -an -electrolyte -abnormality, -while -Q -wave -formation -indicates -total -infarction.
Positive -inotropic -agents -are -used -to:
A. -improve -cardiac -output -and -tissue -perfusion
B. -decrease -water -loss -through -the -kidneys
C. -increase -heart -rate
D. -vasodilate -vessels -- -CORRECT -ANSWER-A. -improve -cardiac -output -and -tissue -perfusion
The -term -"inotropic" -refers -to -affecting -the -force -of -myocardial -contraction. -Improvement -of -
cardiac -muscle -contraction -leads -to -improved -cardiac -output -and -tissue -perfusion.
A -patient -in -the -ED -is -now -being -admitted -to -telemetry -bwith -complaint -of -chest -pain -and -
has -been -judged -to -be -a -possible -candidate -for -therapy -with -alteplase -(Activase). -Which -of -
the -following -is -not -considered -a -contraindication -for -the -use -of -this -medication?
,A. -current -antibiotic -use
B. -recent -abdominal -surgery
C. -recent -gastrointestinal -bleed
D. -recent -intracranial -bleed -- -CORRECT -ANSWER-A. -current -antibiotic -use
Use -of -antibiotics -is -not -a -contraindication -for -the -use -of -alteplase. -All -the -other -answers --- -
recent -abdominal -surgery, -recent -gastrointestinal -bleeding -and -a -recent -intracranial -bleed --- -are
-contraindications -for -the -use -of -any -fibrinolytic.
The -two -major -components -that -determine -blood -pressure -are:
A. -systemic -vascular -resistance -(SVR) -(afterload) -and -cardiac -output
B. -contractility -and -SVR -(afterload)
C. -preload -and -SVR -(afterload)
D. -contractility -and -SVR -(afterload) -- -CORRECT -ANSWER-A. -SVR -(afterload) -and -cardiac -output
The -equation -for -BP -is: -BP -= -SVR -x -cardiac -output.
BP -is -determined -by -resistance -of -the -arterial -bed -and -the -cardiac -output. -If -the -SVR -
(afterload) -is -high -and -the -cardiac -output -low, -the -patient -may -still -have -a -normal -BP. -the -
pulse -pressure -will -be -lower, -but -this -is -a -compensatory -response -by -the -heart -to -maintain -
BP. -If -the -SVR -(afterload) -is -low -(as -in -early -septic -shock), -the -cardiac -output -is -very -high, -
thereby -trying -to -support -BP.
The -layer -of -the -arterial -vessel -wall -responsible -for -changes -in -the -diameter -of -the -artery -is -
the:
A. -media
B. -intima
C. -externa
D. -adventitia -- -CORRECT -ANSWER-A. -media
The -media -layer -of -the -arterial -wall -contains -vascular -smooth -muscle -cells -and -is -responsible -
for -arterial -tone. -Vasoactive -substances -released -in -response -to -the -sympathetic -nervous -system
-and/or -the -renin-angiotensin -system -determine -arterial -tone. -Intima, -externa -and -adventitia -are
-incorrect.
A -patient -presents -in -acute -distress -with -rales -halfway -up -bilaterally; -cool -and -clammy -
extremities; -elevated -jugular -venous -distention -(JVD); -oxygen -saturations -at -95%, -down -from -
, 99%; -and -complaints -of -shortness -of -breath. -Which -of -the -following -findings -correspond -to -the
-patient's -cardiac -status?
A. -no -pulmonary -congestion, -normal -perfusion
B. -no -pulmonary -congestion, -low -perfusion
C. -pulmonary -congestion, -normal -perfusion
D. -pulmonary -congestion, -low -perfusion -- -CORRECT -ANSWER-D. -pulmonary -congestion, -low -
perfusion
Rales -indicate -fluid -in -the -alveolar -sacs, -possibly -secondary -to -pulmonary -edema, -causing -
pulmonary -congestion. -Pneumonia -can -also -cause -fluid -in -the -alveolar -sacs. -The -patient -is -
complaining -of -shortness -of -breath, -and -the -oxygen -saturations -are -lowering, -also -indicating -
that -the -patient -has -pulmonary -congestion. -The -patient's -skin -is -cool -and -clammy, -indicating -
that -the -skin -is -poorly -perfused. -Skin -does -not -require -oxygen -and -shunts -blood -away -in -
decreased -cardiac -function; -therefore, -this -patient -has -pulmonary -congestion -and -low -perfusion
-state. -The -other -answers -are -incorrect.
When -listening -to -heart -sounds, -S1 -signifies -which -of -the -following?
A. -the -beginning -of -ventricular -systole
B. -the -beginning -of -ventricular -diastole
C. -the -propulsion -of -blood -into -a -non-compliant -ventricle
D. -the -blood -going -in -the -wrong -direction -- -CORRECT -ANSWER-A. -the -beginning -of -ventricular -
systole
The -heart -sound -of -S1 -indicates -the -opening -of -the -aortic -and -pulmonic -valves -and -marks -the
-beginning -of -ventricular -systole -or -ejection. -The -beginning -of -diastole -is -after -S2, -propulsion -
of -blood -into -a -noncompliant -chamber -is -S4, -and -blood -going -in -the -wrong -direction -will -
cause -a -murmur.
A -patient -with -pulmonary -edema -has -impaired -diffusion -due -to:
A. -increased -thickness -of -the -alveolar -capillary -membrane
B. -retaining -CO2
C. -an -elevated -body -temperature -associated -with -pulmonary -edema
D. -low -barometric -pressure -- -CORRECT -ANSWER-A. -increased -thickness -of -the -alveolar -capillary -
membrane
With -increasing -left -ventricular -pressures, -blood -moves -back -into -the -left -atrium, -then -to -the -
pulmonary -veins. -When -the -pressure -in -the -pulmonary -veins -increases, -capillary -function -
